The Doctor Is In: Zagat guide for physicians is troubling

If you close your eyes and point your finger to a doctor's name in the phone book, can you be reasonably assured that they know what they're doing just because they carry a medical license? Maybe. But if you want to increase the likelihood of winding up with the best primary care doctor or specialist out there, you'll have to do a bit of research.

There are numerous efforts to rate doctors based on measurable standards to steer you toward the best doctors. The latest company to offer online physician evaluations is Zagat, the well-known restaurant and leisure guide.

But, unlike reviewing restaurants, quality of care in medicine is more complicated than how your food tastes or how your service was.

Zagat recently introduced the Zagat Health Survey Tool in Connecticut and several other states, allowing residents with Anthem Blue Cross insurance to share information about doctors. While the Zagat survey is a serious attempt at trying to point patients toward better doctors, these types of rating systems are fraught with difficulties.

The Zagat reviews are based on a 30-point scale of four criteria: trust, communication, availability, and environment. The potential value is that patients can choose doctors based on what's important to them, whether it's the office atmosphere or the doctor's bedside manner.

But you should really be focusing on quality of care, which isn't measured. Keep in mind, it may be difficult to get an appointment with a world-renowned expert at an academic institution, and his or her office may be a bit dull. But my guess is that's still the kind of doctor most patients would like to see.

We know from medical liability cases that patients aren't always the best judges of good medical care. The vast majority of lawsuits have no evidence of improper care -- they just have a poor outcome. On a ratings systems scale the same might be true: the lion's share of bad reviews may not have any correlation with quality of care. It could be that the patients simply didn't hear what they wanted to hear. I know this may sound condescending, but more and more patients come to an appointment with preconceived notions of what their treatment should be, oftentimes from reading about their symptoms or condition online. And if the doctor's advice differs from what they want to hear, they may get bad reviews.

In gynecology, a patient with large fibroids, severe anemia, and abnormal bleeding may come in with the hope that we will be able to treat her problems with natural approaches like diet, lifestyle changes, and herbal therapies. These may at times achieve a good result. However, if someone has a serious condition, it becomes very unlikely that natural remedies will be recommended, and instead a more effective treatment such as surgery probably will be offered. I've had patients walk out the door and never return because they disagree with my advice, when chances are their choice of treatment wouldn't be effective and may even be a danger to their health. How would they rate me online?

Likewise, a doctor is more likely to get mixed reviews if he or she takes on difficult or complicated cases or works in certain high-risk specialties such as surgery or OB/GYN. In these situations, there's a higher chance of an unsatisfactory outcome. Regardless of the specialty, there's no doctor who's had a universally positive experience with every patient. In fact, almost every doctor over the course of his or her career will be sued by a patient -- more on that subject another time.

Finally, hundreds of reviewers often weigh in on Zagat restaurant reviews; their ratings of doctors are published based on as few as ten evaluations of a particular doctor. Perhaps Zagat should consider not publishing a review until there at least 50 so a clear pattern develops. After all, people's lives and livelihoods are at stake -- not just a meal at a restaurant.

Russell Turk, M.D. is an obstetrician and gynecologist in Fairfield County, Conn. You can ask him your questions about health care issues by leaving a comment.